Best Practices for Active Shooter Incidents

CarolinaFireJournal - By Andrew Rowley
By Andrew Rowley
01/10/2015 -

I think it’s safe to say that no one chooses law enforcement, EMS or fire fighting as a career path without having a desire to serve and help others. We collectively do a fantastic job the majority of the time. But one area that is becoming an increasing risk to first responders in every community, from Los Angeles to the smallest town in Kansas, is active shooter incidents. Two incidents occurred within the United States during the time I was composing this article. So my question is, why are we scared to implement a tactical EMS program within our communities? It should not even be a question. Every community should have a plan, equipment, and education in place for these situations. Aurora and Sandy Hook should be an eye opener to the fact that these incidents are not isolated to larger cities. Yet we continue to avoid it.

The data is there and the position statements from numerous organizations have been published. They all agree a Tactical Combat Casualty Care (TCCC) based approach works. As unfortunate as war is, it drives so many advances — specifically in pre-hospital medicine. An example would be the use of tourniquets. Prior to OIF/OEF tourniquet use was seen almost as voodoo, now it is the standard of care in hemorrhage treatment. So what is next? The military uses a tiered approach to care so that lifesaving care is not delayed. Combat Life Saver being the first level. This is taught to every set of boots on the ground. People who have no medical background and no medical job know how and when to provide basic lifesaving interventions. So why can we not do that in our own towns? The answer is we can.

The data shows time and time again that this approach works. While it must be tailored to fit different communities, it is applicable. Data collected through multiple studies show that even from 2008 to 2012 there has been a 5.2 percent decrease in preventable lives lost. Now this is not an astronomical percentage, so let’s break it down to put it into prospective. During the Vietnam War (1970, Maughon) 7.4 percent of patients passed due to preventable death. A span of 38 years shows almost no change. In 2008 (Kelly) 7.8 percent of patients passed due to preventable death. Much of what was still being practiced was civilian driven trauma care. In the most recent study, 87 percent of patients passed before reaching treatment, 24 percent of which could have been prevented. Ninety-one percent of those deaths were due to hemorrhage. That is an astounding percentage of patients that passed from an easily correctable problem. Why am I throwing all of these numbers from war at you? These Injury patterns are coming home. We have the information; let’s use it wisely.

In 2012 there were 15 FBI deemed “Active Shooter” incidents. In 2013 we surpassed that. This year isn’t even over and the statistic is even higher than the previous. So the focus of stopping the incidents needs to remain, but preparing for and being successful in these situations needs to take priority. Training, cross training and collaboration needs to happen. It has to happen because we can no longer pretend that it “won’t happen here.” Public safety administrators who ignore this need based on budget or stigma, lack education on the subject. While I don’t mean to be insulting, I do mean to be blunt. “Old School” is not the answer anymore, because it has worked doesn’t mean it will continue to. Change needs to happen. I’ve sat in numerous lectures, speeches, and had conversations with those working in cities already involved in active shooter incidents. These organizations have planned, trained and equipped their responders. Police, EMS and fire alike, the officers in Aurora, Colorado now all carry a first aid kit that are “active shooter” driven. They know how to use it. Unfortunately for them, it took a terrible mass shooting to help them see we all need to work together. A paramedic is not always going to be first on scene. On average the range is three to nine minutes in a metropolitan area for an ambulance to respond. If an officer waits until a patient is found to call for a unit, the patient will be dead before arrival. It’s happened too many times. So why can’t we equip the officers with the tools to save patients within 20 seconds? It’s a no brainer. It really requires no intellect to understand, that better training, better equipping and better inter-agency collaboration needs to happen and will save lives. It already has, but it has so much room to improve. I’m hoping that cities and towns will look closely at these statistics and events that have already happened and learn and improve. No one else should lose their life in these situations because they bled out from an extremity waiting for EMS. They lost their life due to a failure to learn and improve from the past.

Tradition has long been a part of the police and fire service. Yet, it fosters the “that’s how it’s always been” mentality. Tradition is an important part of these services, and will always be. With that I will say that it also perpetuates a continuation of the “old way” and in some cases has hindered innovation. The new guys, young guns, and rookies turn to the seasoned guys, to form most of their opinions based off their mentor’s. If the 20 year veteran resists change, so will a new guy in more cases than not. We need to change the attitude of being closed to change. This thought process, unfortunately plagues public service and the safety of the team. While the old way may work, does it work the best? No, active shooter or mass casualty incidents are happening almost weekly. Staging or following how it has been done, is causing life to be lost. I am in no way blaming any responder for the cause of death in victims. I am making a point that finding a shooter or suspect is important, but so is treating the people they may have already injured.

Public safety employees took an oath, whether it be to preserve life and property from fire, protect and serve as an officer, or treat and care for sick and injured, we all do this to save lives. If you don’t put on a uniform every day and think about helping someone, it may be time to consider a career change. My point is, no one will argue that if in the span of a career if one person is saved, that it wasn’t worth it. You’ve chosen a career with a real cause. We need to implement a program to do the most good.

There are multiple organizations now that are centered around providing best practices in care of injured during active shooter and MCI situations. The Committee on Tactical Emergency Casualty Care is probably the most notable. They have taken much of what has been learned overseas and changed it to best fit the civilian population. The future of home front problems, shooters, bombings, and mass casualty incidents are not going anywhere. Numbers don’t lie, so why do we continue to ignore it? These people are dying from injuries in minutes. We need to change the way patients are handled in these situations and it can’t wait. “Train like you fight,” is a common saying, but how often is it really lived? These situations require skills and decisions in seconds. When these situations happen it’s hard to use your brain. Fight or Flight happens and it can’t be ignored. Those who are prepared are going to be successful and in the end more people will see their families when it’s all over. That’s what it’s all about.

Andrew Rowley began his career as a firefighter/EMT at a volunteer fire department. He joined the Army as a medic and is now teaching combat medicine and sustainment at the unit level. He worked in Charlotte, North Carolina for Mecklenburg EMS Agency, as a paramedic. Rowley’s current position is flight paramedic with Wake Forest Baptist Health in Winston-Salem, North Carolina. He is the president of Special Operations Aid and Rescue, LLC, a company that provides tactical medicine training and equipment to fire, EMS and law enforcement. He also currently works with the Board for Critical Care Transport Paramedic Certification, writing and reviewing questions that are used in both the Certified Flight and Tactical Paramedic Certification exams.
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